What’s Going On in Oregon?

Think Oregon’s assisted suicide law is killing people “safely”? W. Carol Cleigh has gone through the annual reports, and what she finds is alarming, in terms of what we know and in terms of what we will never know. Here’s her article, in italics:

It has been widely asserted in the media storm promoting Physician Assisted Suicide since the death of Brittany Maynard, that there are no abuses of the Oregon ‘Death with Dignity Act’ (DWDA). But is that true? I got curious and this is the result.

Initially, the DWDA was only for long-term residents of Oregon. This changed some time in the past 15 years, but under the original law, Maynard wouldn’t have been eligible since one had to live in Oregon for six months or longer to qualify. While it’s not ‘suicide tourism,’ it seems to trend in that direction. All one must do now is have an Oregon drivers license.

Anyone with a calculator can determine from the report that the Oregon public health agency posts each year that there has been a greater than 500% increase in the number of lethal prescriptions written annually and a corresponding greater than 500% increase in deaths.* That is fairly startling.

Overall, during the past 15 years, a mere 6% have been referred for “formal psychiatric or psychological evaluation.” That is pitiful. What is even worse, though, is that even that number seems to be declining. Last year, fewer than 3% were referred. This seems to mean that the physicians prescribing these drugs feel that they are capable of spotting treatable depression and ‘weeding out’ those who have it or they simply don’t care. This is less surprising given that only 62 of Oregon’s more than 11,700 physicians# wrote all of the lethal prescriptions last year. This means that ½ of 1% of the physicians in Oregon write such prescriptions, many wrote several and one wrote 14% of them. Death seems to have become a specialty.

Another disturbing trend in Oregon is an increase in the number of people who had only Medicare/Medicaid at the time they ‘chose’ DWDA (53% this year vs. 34% during previous years). Given that we’ve seen more than one case where Medicaid denied coverage for life-extending treatments and even for effective painkillers, then made the point that DWDA was covered in their denial letters, this trend is ominous. It is even more so when coupled with the increase in “burden on family, friends/caregivers” as a reason to take the lethal prescription (49% this year vs. 39% previously). The ‘end of life concern’ labeled “financial implications of treatment” has also nearly doubled this year, from less than 3% to more than 5.5%. Are people in Oregon killing themselves for money? It would certainly seem so and it would seem that this is on the increase.

There is another trend that is difficult to evaluate. A lot fewer of those who used the DWDA this year had cancer than in previous years (65% vs. 80% in previous years). There has been a corresponding increase in “chronic lower respiratory disease” and “other illness.” It is difficult, however, to say what this trend may portend as all of these categories are check marks on a form the physicians who write these poison prescriptions turn in voluntarily. There is no meaningful oversight when all reporting is voluntary.

The “other illness” category is troubling in itself as it includes: “benign and uncertain neoplasms, other respiratory diseases, diseases of the nervous system (including multiple sclerosis, Parkinson’s disease and Huntington’s disease), musculoskeletal and connective tissue diseases, viral hepatitis, diabetes mellitus, cerebrovascular disease, and alcoholic liver disease.”* Since several of these are long-term disabling conditions that are often mistaken for terminal illnesses, this is a category you could load up a bus with non-terminal disabled people and drive through. For all we know, people could be dying rather than adjusting to disabling conditions. That the number of deaths in this troubling category has more than trebled in the past year is disquieting.

Then there is the problem of lethal prescriptions that aren’t used. Where are they? Who has them? There is no requirement that they be returned or destroyed. At the end of 2013 there were more than 420 lethal prescriptions unaccounted for. That is enough to kill several years’ worth of people reported to die under the DWDA. Is there a ‘black market’ in these ‘unused’ lethal prescriptions? We don’t know because no one is investigating. It doesn’t seem to bother the Oregon department of public health that there are several hundred of bottles of Secobarbital and Pentobarbital without any proper control.

What seems to have happened in Oregon is that people in distress, or their families (caregivers, etc.); contact Compassion & Choices (Hemlock Society). C&C assigns a volunteer to ‘help’ them through the process. They, of course, know the ‘right’ physicians that will not question motives or psychological health. This volunteer goes so far as to mix the poison for them and, presumably, to help them ingest it if necessary.@ This is why the average length of the physician-patient relationship is only 13 weeks (90 days) and in some cases spans only 1week (in violation of the DWDA as it is supposed to take 15 days to get the prescription).

Death has become an industry in Oregon and C&C essentially controls it. If lethal prescriptions are not used, do their volunteers keep them? Since C&C’s stated intent is to ‘help’ non-terminal disabled people and others not covered by DWDA die,** are they using these ‘spare’ prescriptions for that purpose?

So, is there abuse of the DWDA in Oregon? The simple answer is yes. There are some abuses showing through even in the voluntary reports, but there are a lot more questions. Are there major abuses? Maybe. We may never know, but with an organization with the stated objectives and shady past of C&C essentially in charge of the process, it’s very likely.

Carol Cleigh is a writer and disability rights activist; while living in Chicago, she served on the boards of Not Dead Yet, Progress Center for Independent Living, Chicago ADAPT and the Council for Disability Rights. She co-founded Suburban Access Squad, served on the Pace, Metra and CTA ADA advisory committees and wrote for the Ragged Edge. In 2003, she retired to the mountains of Western North Carolina where she continues her activism at a much slower pace.